Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape

Abstract

We evaluated the results of surgical treatment for pediatric displaced supracondylar humerus fractures. The study included 98 pediatric patients (72 boys, 26 girls; mean age 7 years; range 3 months to 14 years). According to the Gartland classification, all the displaced supracondylar humerus fractures were type III, being of flexion type in 10 patients (10.2%), and extension type in 88 patients (89.8%). Five were Gustilo-Anderson type 1 open fractures. All fractures were approached posteriorly. Reduction was achieved by cutting the triceps muscle in a reverse V-shape, followed by fixation using two cross K-wires from the epicondyles. The results were assessed according to the criteria of Flynn et al. At final follow-ups, elbow range of motion, the strength of the triceps muscle and, on radiographs, the carrying angle of the elbow, Baumann angle, and lateral humerocapitellar angle were measured. The mean follow-up was 42.6 months (range 7 to 80 months). According to the criteria of Flynn et al., 95 patients (96.9%) had perfect or good cosmetic results, 84 patients (85.7%) had perfect or good functional results. Elbow angles, elbow range of motion, and the strength of the triceps muscle were similar to those measured on the normal side (p>0.05). Time from injury to surgery did not have a significant influence on cosmetic and functional results (p>0.05). None of the patients exhibited procedure-related pin tract infection or insufficient bone union. Three patients (3.1%) developed cubitus varus deformity. Reduction of pediatric displaced supracondylar humerus fractures may be achieved easily by the posterior approach, after cutting the triceps muscle in a reverse V-shape, and fixation with two cross-pinned K-wires provides adequate stability. This procedure does not result in weakness of the triceps muscle.